• The Korean Journal of Pain
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• v.33 no.3
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• pp.234-244
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• 2020

Background: Chronic pain affects approximately 22% of the world's population. Opioids can be useful in chronic pain management. However, some patients have negative perception of opioids. The purpose of this research was to evaluate patients' perception about opioids and investigate problems associated with prescribing and taking opioids in South Korea. Methods: Patients who visited a pain clinic in 14 university hospitals of South Korea from September through October 2018 were asked to complete anonymous questionnaires about taking opioids. Results: Of the 368 patients that were surveyed (female 53.3%, male 46.7%), 56.8% were prescribed opioids. In the opioid group, 92.8% patients had heard of opioids from their doctor and 72.6% of them had a positive perception about opioids. The side effects associated with opioid use were constipation (35.4%), dizziness (24.6%), nausea and vomiting (17.4%), dysuria (6.2%), and addiction (2.0%). In the no opioid group, the primary sources of information about opioids were doctors (49.2%), mass media (30.8%), and the internet (16.2%). The main reasons why 39.0% patients did not take opioids were fear of addiction (57.7%) and side effects (38.5%). There were 71.5% and 60.9% patients in the opioid and no opioid group, respectively, who wished to take opioids when their numeric rating scale pain score was ≥ 7. Conclusions: Perception of opioids among patients who take them was either neutral or positive. However, 39.0% patients who have not been prescribed opioids did not want an opioid prescription, citing fear of addiction and side effects as the primary reasons.

• Asian Oncology Nursing
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• v.9 no.2
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• pp.104-113
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• 2009

Purpose: The aim of this study was to investigate pain management knowledge and attitude in cancer patients and their family caregivers. Methods: The subjects were 52 hospitalized cancer patients and 52 their family caregivers in a hematooncologic unit in one general hospital. Data were collected via self-reported questionnaires and interviews in 2008. Results: 46.2% of the patient participants reported pain and 50% of them were taking opioid analgesics. Levels of knowledge about cancer pain and its management in both patient and caregiver participants were low, whereas, the scores of knowledge of the caregivers were significantly higher than that of the patients. The attitudes toward cancer pain were not significantly different between patients and caregivers. Both cancer patients and caregivers had some misconcepts in using opioid analgesics and about cancer pain. Patients' and caregivers' level of knowledge about cancer pain and its mangement demonstrated positive correlation. Conclusion: Education about cancer pain and its management should target both cancer patients and their family caregivers. Also the education should focus on intervening the misconceptions that patients and their caregivers have regarding cancer pain and its management.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.738-743
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• 2000

Background: Video-assisted thoracic surgery(VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. Material and Method: Group I (n=18) underwent video-assisted thoracic surgery, and group II(n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. Result: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I(155.6$\pm$77.8cc) than in group II(572.8$\pm$280.1cc)(p<0.05). Conclusion: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.95-100
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• 1999

Background: About 75% of terminal cancer patients have severe pain. For the treatment of these patients, physicians usually use potent opioid analgesics. But many of the cancer patients were not controlled by IV or IM injection of opioids. In spite of the untreatable nature of the patient's illness, they should be hospitalized only for pain control. In that case, epidural opioid injection is one of the most effective methods in pain management. Methods: We retrospectively analyzed 126 terminal cancer patients who were treated with epidural morphine for pain management from 1993-97. In the routine procedure, an epidural catheter was inserted into the epidural space and tunnelled subcutaneously, exiting out from the anterior chest or abdomen. Morphine was used as the main analgesic and Multiday Infusor$^{(R)}$ (Baxter, 0.5 ml/h) as a continuous infusion system. Results: 1. Mean treatment time was 55 days (range; 3~373). 2. Mean daily epidural start mg dose of morphine was 8 mg (range; 2~20). 3. Mean daily dose at termination was 19 mg (range; 4~60) 4. 94 patients were controlled with continuous infusion but 32 patients needed additional bolus doses of morphine. 5. heter-associated subcutaneous infection occurred in 2 patients (1.6%). Conclusion: Terminal cancer pain management administered by a tunnelled epidural catheter is a simple, inexpensive method with a very small rate of infection.

• Korean Journal of Hospice Care
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• v.5 no.2
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• pp.15-21
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• 2005

Purpose: This study was designed to evaluate the perception of cancer in aspirants for hospice volunteer. Methods: Aspirants for hospice volunteer were surveyed by questionnaire before education of hospice program in September 2005 at Pyongan Hospice Center of Sam Anyang Hospital. The questionnaire was composed of total 28 items. Ten items were general characteristics and the remaining 18 items knowledge, attitude and practice of cancer and cancer pain. The data were analyzed by SPSS WIN 11.0 program using frequency, mean, percentage. Results: Eighty nine questionnaires were returned. There were 6 males and 83 females, and median age of aspirants was 46 years. Forty five aspirants(51%) had a cancer patient in th family or relatives and the others 44(49%) not. Forty eight(54%) had favorable attitude about modern clinical medicine for cancer treatment and the others 39(44%) unfavorable. Fifty eight(65%) had favorable attitude about complementary and alternative medicine for cancer treatment and the others 20(23%). In response to the question about 'How illness is a cancer', 25 aspirants(25%) responded to chronic disease, 42(47%) suffering incurable disease, the others 17(19%) death sentence, respectively. A number of aspirants had wrong knowledge and understanding of cancer, cancer pain and opioid analgesics. Seventy one percent aspirants feared cancer pain. Conclusion: The credibility to modern clinical medicine for cancer treatment was relatively low in aspirants for hospice volunteer compared with complementary and alternative medicine. They recognized a cancer as suffering incurable disease and death sentence than chronic disease. A number of aspirants had wrong knowledge of cancer, cancer pain and opioid analgesics. Therefore, further studies and trial will be warranted to evaluated the causes of these results and improve the credibility of modern clinical medicine for cancer treatment in general population.

• The Korean Journal of Pain
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• v.34 no.2
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• pp.201-209
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• 2021

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. Methods: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. Results: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. Conclusions: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.129-143
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• 2022

Background: Patient-controlled analgesia (PCA) has been widely used as an effective medical treatment for pain and for postoperative analgesia. However, improper dose errors in intravenous (IV) administration of narcotic analgesics from a PCA infusion pump can cause patient harm. Furthermore, opioid overdose is considered one of the highest risk factors for patients receiving pain medications. Therefore, accurate delivery of opioid analgesics is a critical function of PCA infusion pumps. Methods: We designed a microbalance method that consisted of a closed acrylic chamber containing a layer and an oil layer with an electronic balance. A commercially available infusion analyzer (IDA-5, Fluke Co., Everett, WA, USA) was used to measure the accuracy of the infusion flow rate from a commercially available smart PCA infusion pump (PS-1000, UNIMEDICS, Co., Ltd., Seoul, Korea) and compared with the results of the microbalance method. We evaluated the uncertainty of the flow rate measurement using the ISO guide (GUM:1995 part3). The battery life, delay time of the occlusion alarm, and bolus function of the PCA pump were also tested. Results: The microbalance method was good in the short-term 2 h measurement, and IDA-5 was good in the long-term 24 h measurement. The two measurement systems can complement each other in the case of the measurement time. Regarding battery performance, PS-1000 lasted approximately 5 days in a 1 ml/hr flow rate condition without recharging the battery. The occlusion pressure alarm delays of PS-1000 satisfied the conventional alarm threshold of occlusion pressure (300-800 mmHg). Average accuracy bolus volume was measured as 63%, 95%, and 98.5% with 0.1 ml, 1 ml, and 2 ml bolus volume presets, respectively. A 1 ml/hr flow rate measurement was evaluated as 2.08% of expanded uncertainty, with a 95% confidence level. Conclusion: PS-1000 showed a flow accuracy to be within the infusion pump standard, which is ± 5% of flow accuracy. Occlusion alarm of PS-1000 was quickly transmitted, resulting in better safety for patients receiving IV infusion of opioids. PS-1000 is sufficient for a portable smart PCA infusion pump.

• Journal of Korean Clinical Nursing Research
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• v.30 no.1
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• pp.45-53
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• 2024

Purpose: This study aimed to investigate the effectiveness of preoperative patient-controlled analgesia(PCA) education program on older patients with spine surgery. Methods: A quasi-experimental research with a non-equivalent control group pretest-posttest design was conducted to investigate the impact of a PCA education program before surgery on postoperative pain, pain knowledge and attitudes, and frequency of additional analgesic use. The sample size for experimental and control group was 55 respectively. Results: The experimental group, which underwent the PCA education program, had lower postoperative pain scores compared to the control group. Furthermore, the experimental group exhibited a higher level of knowledge on PCA (p<.001) and more positive attitudes toward analgesic use (p<.001). While there was a significant difference in the use of opioid analgesics for additional pain relief between two groups (p<.001), there was no significant difference in the use of non-opioid analgesics. Conclusion: The implementation of the PCA education program was found to increase knowledge and positive attitudes on the use of PCA. Moreover, it significantly alleviated pain, particularly during physical activity, within initial 48 hours after spinal surgey in older patients. Therefore, the findings of this study supported that the PCA education program could be used as a preoperative intervention to alleviate postoperative pain for older patients with spinal surgery.

• Korean Journal of Clinical Pharmacy
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• v.28 no.4
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• pp.279-284
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• 2018

Objective: To compare the analgesic effects and adverse drug reactions (ADRs) of fentanyl intravenous patient-controlled analgesia (ivPCA) with nefopam, a centrally acting analgesic agent with demonstrated opioid sparing activity, as compared to ketorolac in a tertiary teaching hospital. Methods: A retrospective evaluation of electronic medical records was conducted on patient records including either nefopam or ketorolac with opioid ivPCA for post-operative pain management in general surgery department from January to December 2014. The status of pain control and ADRs were collected. Results: Out of 6,330 general surgery cases, nefopam was given in 153 prescriptions (6.9%) and ketorolac in 81 prescriptions (3.6%). The level of pain control was not different between two groups (70.9% vs. 75.3%; p = 0.51), but ADRs were more frequently reported in nefopam group (9.8% vs. 2.5%; p < 0.05). New ADRs of hot flushes (n = 1) and paresthesia in hands (n = 1) were reported in nefopam group and they were unlisted in the approved package insert. No serious ADRs were reported in both groups. Conclusion: Our findings presented that nefopam showed a similar analgesic effect and higher ADR rates compared to ketorolac as an adjuvant to fentanyl iv PCA for post-operative pain management in general surgery patients in South Korea.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.131-135
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• 2017

Purpose: Oral naloxone is combined with oxycodone to alleviate or prevent opioid-induced constipation in cancer pain patients. However, there is still concern that oral naloxone may precipitate opioid withdrawal symptoms in patients on opioids. We retrospectively investigated clinical characteristics of cancer patients who experienced opioid withdrawal symptoms. Methods: We reviewed medical records of all patients who were prescribed with oral oxycodone/naloxone at a tertiary cancer center from January 1, 2012 through December 31, 2016. Eligible patients were screened based on demographics, opioid and naloxone dosages, clinical manifestation and pain intensity. Results: Among a total of 1,641 patients, 10 patients were selected. Seven patients were male, and the average age was 68.1 years. The median dose of naloxone that induced withdrawal symptoms was 20 mg. Most common withdrawal symptom was shivering (seven patients) followed by cold sweating (five), and muscle twitching (five). Other symptoms included restlessness, fever, dizziness, and yawning. Pain was exacerbated from the median intensity of numeric rating scale (NRS) 3 to NRS 6. Conclusion: Opioid withdrawal symptoms may occur when switching to oral oxycodone/naloxone for cancer patients who have been treated with other strong opioids. A prospective, multicenter study on this issue should be conducted in future.